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    Personal Information Sheet (PIS) p1 - 20jun2023 - Final

    Uploaded by

    Than Mercado

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Personal Information Sheet (PIS) p1 - 20jun2023 - Final

    Uploaded by

    Than Mercado
    4 views1 page

    Original Title

    Personal Information Sheet (PIS) p1_20Jun2023_final

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    4 views1 page

    Personal Information Sheet (PIS) p1 - 20jun2023 - Final

    Uploaded by

    Than Mercado

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    2x2 ID picture

    White Background
    FWD Life Insurance Corporation Formal Attire
    9/F W Fifth Avenue Building, 5th Avenue corner 32nd Street
    Bonifacio Global City, Taguig City, 1634 Philippines
    Tel: (632) 8888-8388

    PERSONAL INFORMATION SHEET


    Please use UPPER CASE (ex. JUAN DELA CRUZ)
    Designation: Agency Partner FWD FWBM FWM FWP

    Source: Acquisition/IRP No Program (Organic)

    Applying For: Traditional Only Variable Only Dual

    Catherine M. Alejo 10018825


    Recruiter: _____________________________________________ _______________ ___________________
    Signature over printed name Agent ID Date signed

    Personal Data:
    Title First Name Middle Name Last Name Nickname
    MR JHUNWARDTHAN ARENDELA MERCADO THAN
    Residence Address: Zip Code:
    BUCAL 1 MARAGONDON,, CAVITE 4112
    Business Address: Zip Code:
    N/A
    Age: Date of Birth: Nationality: Gender: Mobile No. 1
    21 JUNE 9, 2002 FILIPINO ■ Male Female 09976529446
    Marital Status: Spouse name if Married: Government Employee? Birthplace: Mobile No. 2
    SINGLE N/A Yes ■ No TRECE MARTIRES, CITY 09108628914
    TIN#: SSS#: Religion: Email Address: (yahoo.com or gmail.com only)
    645-890-263-00000 CATHOLIC JHUNWARDM@GMAIL.COM
    Mother’s Maiden Name: NORA NUESTRO ARENDELA

    Occupation details (For the Last 5 years):


    COMPANY POSITION PERIOD (MM/DD/YYYY) REASON FOR LEAVING
    FROM TO
    N/A N/A N/A N/A

    Dependents:
    NAME AGE STATUS RELATION TO AGENT
    EUNICE ARENDELA 31 SINGLE SISTER
    NORA MERCADO 53 MARRIED MOTHER
    Contact Person in case of Emergency Full Name: MERCADO JOHNAARON ARENDELA Mobile Number: 09976529297

    Other details:
    Classroom ESC Date, Location, & Trainor (submit Certificate Traditional Exam Date, Location, & Company Variable Exam Date, Location, &
    of Elite Starter Course ESC) Company

    I hereby affirm that my answers to the foregoing questions are true and correct and that any falsification made herein shall be taken as sufficient grounds for
    disqualification on my application or my dismissal from the Company. I authorize the Company to collect, process, store, modify and destroy my
    information, as well as disclose, share or transfer this information to its principal, subsidiaries, affiliates, partners, agents, representatives, outsourced service
    providers, and to regulatory authorities or government entities, for legitimate purposes, including but not limited to:
    i. Process my application, including assisting me in my application for license to the Insurance Commission, conducting any background checks.
    ii. Administer my commissions, overrides, other benefits and entitlements, if any.
    iii. Provide advice or information covering products, services, promotions, contest, customer related services and the like, or communicate with me
    through mail/email/social media account/fax/SMS/telephone for any purpose.
    iv. Manage, review and analyze results of my information, production, and other performance-based results for data analytics.
    v. Comply with applicable laws or regulations.

    Jhunwardthan A Mercado March 26, 2024


    ___________________________________ _________________________
    Signature over Printed Name of Applicant Date signed

    For Agency Leaders:


    I hereby certify that the agent - applicant possess the qualifications prosecuted by the Office of the Insurance Commission in the licensing of agents.

    JORINAH B. MANABAT 10012564


    Immediate Leader: _______________________________________________ _______________ ___________________
    Signature over printed name Agent ID Date signed

    MA RENELIA AVILA 10009036


    Second line Leader ________________________________________________ _______________ ___________________
    Signature over printed name Agent ID Date signed

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